HospitalInspections.org

Based on observation, interview, record review, and a review of the facility policy it was determined the facility failed to ensure that specific food and dietetic organization requirements were met related to food storage and ensuring infection control measures were implemented when food was prepared or served in the facility. Observations conducted on 07/05/16 of food stored in the facility's walk-in freezer, walk-in cooler, and the dry food storage area revealed food items had not been dated with an expiration date as required. Expired foods were also observed in the facility's dry storage area. Observations on 07/05/16 of Dietary Employee #1 revealed he was serving food in the facility during the noon meal without utilizing appropriate hair restraints as required.

The findings include:

Review of the facility policy titled "Food Storage," last revised 06/27/16, revealed all food products would be marked with the date the item was received by Dietary Services. The policy also stated food would be discarded before an expiration date, and if there were questions about a product's storage or expiration, the product would be discarded.

Review of the facility policy titled "Personal Hygiene," dated 2001, revealed hair would be clean and trimmed, and no hats would be worn in the facility.

1. Observations conducted with the Dietary Manager (DM) of the facility's walk-in freezer on 07/05/16 at 11:00 AM revealed twenty bags of frozen broccoli, eight bags of frozen cauliflower, eight bags of frozen corn, and ten bags of frozen chicken breast with no expiration date observed.

Observations conducted with the DM of the facility's walk-in cooler on 07/05/16 at 11:25 AM revealed six 2-pound bags of shredded cheddar cheese, three 5-pound blocks of unopened American cheese, and two 2-pound bags of mozzarella cheese with no expiration dates observed on the food packaging. An approximately 2-pound unopened package of bologna was also stored in the facility's walk-in cooler and had no expiration date observed.

Observations conducted with Dietary Employee #2 of the facility's dry food storage area on 07/05/16 at 12:00 PM revealed six 12-count packages of flour tortillas with May 2016 as an expiration date (approximately two months ago). Further observations revealed three 2-pound boxes of instant potatoes, five bags of cheesecake mix, and thirteen bags of biscuit gravy mix with no expiration date observed on the packaging.

2. Observation of Dietary Employee #1 on 07/05/16 at 12:10 PM revealed he was serving food in the facility dining room to employees and visitors, with a hat on, which failed to cover the back portion of his hair.

Interview with Dietary Employee #1 on 07/05/16 at 12:15 PM revealed he prepared and served foods frequently to patients in the facility. He stated he was "told a hat would be fine" and he had never been instructed to ensure his hair was completely covered.
Interview with the DM on 07/05/16 at 11:10 AM revealed she was not aware of when the foods observed on tour in the dietary storage areas would expire. The DM stated the expiration dates were usually located on the packaging that the foods arrived in at the facility. However, those packages had been discarded. She stated she had not been trained to ensure all food items had an expiration date on the packaging. However, she stated, "That makes sense to have all food dated, so we know when they expire." She stated all employees were responsible to check daily for expired foods and was not aware foods that were past the expiration date were in the facility's dry storage area. The DM stated Employee #1 had utilized a hat, which left hair exposed in the back, since his employment began with the facility. She acknowledged that employees which failed to cover all exposed hair increased the infection control concern of patients' food items becoming contaminated with Employee #1's hair.

Based on observation, interview, and record review it was determined the facility failed to ensure a qualified dietitian supervised the nutritional aspects of patient care in the facility. Interviews with dietary, clinical, and administrative staff on 07/05/16 revealed a Registered Dietitian (RD) had not been employed at the facility since December 2015. Interview with the Community Chief Executive Officer (CCEO) confirmed the facility had not employed an RD since December 2015, and he stated he was not aware that it was a requirement.

The findings include:

Interview with the CCEO on 07/05/16 at 3:40 PM revealed the facility had no policy related to the requirement or employment of an RD in the facility.

Interview with the Dietary Manager (DM) on 07/05/16 at 11:10 AM revealed there had not been an RD employed or available for consultation at the facility since December 2015. The DM stated the Dietary Department utilized the diet menus that had been developed by the RD that was previously employed at the facility.

Interview with Physician #1 on 07/05/16 at 2:00 PM revealed there had been times he would have ordered an RD consultation for a facility patient but had not ordered a consultation because "it's a known fact there's not one available here, and hasn't been for a while." The physician continued to state he felt it was "standard" for patients to have an RD available to ensure their nutritional needs are met while at the facility.

Interview with the CCEO on 07/05/16 at 3:40 PM revealed there had not been an RD employed with the facility, even on a consultant basis, as required since December 2015. He acknowledged he was responsible for the daily functioning of the facility. However, he was not aware the facility was required to ensure an RD was employed at the facility to supervise the nutritional aspects of patient care.